Does anyone have experience getting a pharmacy to compound Oxytocin nasal
spray? How would I go about it? I think it may help my client. Mom gave
her permission to post. I tried to be brief and mention just the
pertinent.

Her first baby was failure to thrive but started thriving with formula
supplementation. She breastfed and supplemented until baby was 6 months.

Here's a brief synopsis:
Birthweight 9 lb 5 oz
Day 2         8 lb 8 oz Exclusively breastfed
Day 7         8 lb 13 oz  Exclusively breastfed. Ped said everything is
fine-                 come back in 3 wks.
Day 14       8 lbs 12.5 oz  They came to see me. Mom didn't think there
was a problem as baby woke for feeds 10-11 times per day, fed for 15-20
min per breast and was content afterward. She just didn't want another
FFT baby. Stools were still green. For the next 11days after our initial
consult, mom breastfed then supplemented all the EBM she could pump after
feeds (SNS or fingerfeeding used). Mom is very diligent and has insisted
on pumping after every feeding. I usually recommend just breastfeeding in
the middle of night and not pumping. We checked his weight every 2-3
days.

Day 25--weight is 9-1.5 (That's a 4.5 oz gain in 11 days on BF + EBM. Mom
slacked off on the supplementing for 2 days during this time as she
thought he was doing more swallowing. Gain was 2oz in 5 days with little
supplement). I realize he would probably be OK gaining 1/2 oz per day but
I was more worried about her supply. Now, 6-8 oz formula/day is added.

Day 28  weight is 9 lb 7.5 oz  Saw ped. He was supportive, will accept a
4oz gain per week, and told her to keep working with me.
Now, 6 wks of age--10 lb-13oz. He's gaining well but mom is still pumping
after each feeding (about 8 per day) and he's getting 12-16 oz supplement
per day (4-8 oz is ABM).

Other info: Despite wide nipples, mom latches him well and nipples are
not pinched or flattened when he comes off. There has been no nipple
trauma- still felt initial latch "twinge" at 2 weeks. His suck looks
fine. No jaundice. He starts out very alert when in his nutritive phase
which only lasts about 5 minutes per breast (with a 1:1 or 2:1
suck:swallow ratio). She switch nurses and he has another brief nutritive
phase. After that, his eyes are closed and he changes to 5-6 sucks per
swallow. Then, mom can pump 1.5-2.5 oz. She's using a good pump, has
changed to large flanges, and the fit is appropriate. Her breasts
increased about 1 cup size during pregnancy and she had breast
tenderness. She doesn't want to take Reglan, is taking Fenugree, and has
ordered Domperidone. Husband is supportive and helps. She has help with
her other child. She spoke to her MD about thyroid levels but he didn't
check them. Her supply has increased but his intake while breastfeeding
has not. She did change from fingerfeeding to bottles at 4 weeks. I do
not see a difference in his latch since bottles were started. She has
tried the SNS again but says it gets kinked off and takes forever- it has
only worked well for her a few times.

I'm wondering if some Oxytocin would strengthen the second letdown when
he's on the breast and help him receive more milk per feeding. Mom says
she will resort to exclusive pumping if he doesn't get better but she is
hanging in there very strongly to see what the Domperidone does.
Hopefully, if it gives her an abundant supply, he will take in enough
from the breast to fill him up and make him gain well. Now, baby never
gets a full feeding at the breast so he wants a supplement after each
feeding. Let's say she never reaches a fully supply with the
Domperidone--it would be much easier (convenient, rewarding, etc.) if she
just needed to supplement a few feedings per day instead of after each
one.

Yesterday, she and I discussed the fact that maybe he is now being
overfed--I explained how babies will often take more than they need/want
from a bottle if the milk and nipple are there. She says Dad gives more
in the bottle than she does. I really feel mom is very close to producing
enough for adequate gain now-he just wont get it out! I suggested she try
frequent breastfeedings (as often as he wants) with switch nursing and
not pumping or supplementing. He does know when he is hungry. She tried
this approach for most of yesterday and he just cried after feedings,
even if she switch nursed him for an hour. She will try supplementing
with smaller amounts of EBM and no ABM to see how he does.

Suggestions are appreciated. Does anyone think Oxytocin would help in
this situation? What else can be done to get him to empty the breast
better? I thought he'd do much better after he surpassed his birthweight
but he hasn't. I don't think there are any OT's or SLT's around here
experienced with helping breastfeeding babies.

Thanks, Kris Wiedman RN IBCLC (private practice in TN)

________________________________________________________________
Sign Up for Juno Platinum Internet Access Today
Only $9.95 per month!
Visit www.juno.com

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html